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1st post - Sturggling with fatigue - OSCAR results attatched
#1
1st post - Sturggling with fatigue - OSCAR results attatched
   
   

Hello,
I was diagnosed with OSA about a year ago. I've been told that an AHI of 5 and under is good, but mine is often above this. I see other people on this forum with much lower AHI and would like to know if there is anything I can do to lower this. I use my machine with a full face mask religiously (usually for 7+ hrs every night), but I still feel like I've been hit by a truck! The few times when I have had an AHI of 3 or under, I've felt great! I have stuffy sinuses, but using flonaze and the humidifier help this somewhat.

I have attached two nights of OSCAR results.

I tried to upload my sleep study results, but it seems I can't download a pdf until I do 4 posts. It's okay, I can give you the highlights:
  • height: 5'2", weight: 120 lbs, age: 59
  • In total, 30 apneas were recorded. Of these 29 were obstructive, 1 mixed and 0 centrals. This resulted in an apnea index of 5.6/hr. 117 hypopneas were recorded or 21.8 hypopneas/hr. Overall AHI: 27.4 events/hr, while AHI during Stage R sleep was 54.1/hr.
  • usually sleep on side
  • RDI: 56.6 events/hr
  • 52.0 arousals/hr
  • SpO2 value - 92.9%, minimum saturation - 82.0%, O2 saturations below 88% for 10.4 minutes of time asleep
Interpretation: Moderate Obstructive Sleep Apnea with more frequent sleep fragmentation, without hypoxemia.

I have tried to interpret this data myself, but my ability to concentrate -- even to write this and figure out how to use OSCAR and this message board is taxing. I feel like I bought this machine and was left to figure out what to do on my own. I appreciate the effort that the volunteers on this site do to help those of us struggling to cope with this diagnosis.
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#2
RE: 1st post - Sturggling with fatigue - OSCAR results attatched
Welcome to Apnea Board,

It looks like another case of positional Apnea where a soft cervical collar will inhibit airway kinking from chin tucking. There may be other setting adjustments, but do read the wiki on this positional Apnea and give one a try and the first step. The wiki link is in my signature. The tell for this positional Apnea is those clusters of Obstructive and hypopnea events. The fix is either flattening your pillows as in if you sleep on several, remove most leaving one. Or try a soft cervical collar.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: 1st post - Sturggling with fatigue - OSCAR results attatched
SarcasticDave94,

Thank you for your advice and quick reply! I've never heard of chin tucking being an issue, and as you state in the wiki, this is not something you will hear about from a sleep clinic. I will experiment to see what will work for me and get back to you with my results.

Feeling hopeful!

SeekingSleep
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#4
RE: 1st post - Sturggling with fatigue - OSCAR results attatched
Welcome there are a lot of very smart people here that will help. 

Let ma start the discussion. Why are you on straight Cpap?

I see some positional apnea. What is positional apnea?  It is when you get into a position while sleeping that cuts off your own airway. And NO changes of settings can help. The only way is to stop getting into that position. No more back sleeping. Use a lower pillow. If that is not enough use a collar. Check the link at the bottom of the post on collars. 

 Positional apnea is when you touch your chin down to your Sternum cutting off your airway. It is that simple but sometimes hard to correct. Many people have had great relief using collars 

Also I would turn off the ramp. While you have it on you are NOT Getting any therapy because
Use it’s pressure is not enough to help. 

Getting back to the first question, most people find autoset better than straight Cpap. Some people find straight Cpap needed because of central, so again why are you on Cpap?
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#5
RE: 1st post - Sturggling with fatigue - OSCAR results attatched
Staceyburke,

You're right! There are a lot of smart people on this site. I'm so impressed by the fact that not only one, but two people have already responded to my post! Thank you!

Regarding your question as to why I am on straight CPAP? The prescription I got last March was: auto + 5-15 cmH20, ramp + 5 cmHW0 at 5 minutes. My AHI was too high, so it was set to what it is now. It seemed to help for a while, but for the past 6 months or so, it's been getting worse. Other than the place I bought the machine telling me it might be due to mask leakage, I haven't had any other suggestions. And, quite frankly, I don't feel I'm being heard, which is why I joined this site.

Thanks for the ramp suggestion, but that is the one thing I think I will keep. I found full pressure right away difficult as it takes me some time to fall asleep and my sinuses need time to adjust. I usually put on the radio for a while after getting into bed along with the ramp, so I'm not really sleeping. The radio and starting out slow with the ramp allows me to relax a bit and my sinuses to clear, so I can tolerate the higher pressure.

I'm planning to try the cervical collar to see if there's any improvement. If it works, I will take your advice and try going back to auto to see if it gets even better. 

Thanks so much for your advice and responding to my post! I haven't felt this hopeful in quite some time!

SeekingSleep
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#6
RE: 1st post - Sturggling with fatigue - OSCAR results attatched
I understand about the ramp but that may be because you are on straight Cpap which means the pressure never changes on inhale or exhale.

You of course should do what seems best for you but I would suggest you try the following-

Min 7
Max 12
A flex 2
Ramp off

That should give you enough air on inhale, make exhale easier and give you better control of your apnea.

If you don’t like it you can quickly change back.

And please do look into a collar.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#7
RE: 1st post - Sturggling with fatigue - OSCAR results attatched
Thanks so much,

I will experiment for a bit and get back to you with the results.

Have a great day!
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#8
RE: 1st post - Sturggling with fatigue - OSCAR results attatched
Great advice by Stacey above. I just wanted to say that for me, changing to a much flatter pillow made all the difference for my positional apneas when I was starting out. That may be enough for you too or it may not. Might be worth a shot before you go the collar route. I myself prefer to sleep with less items on my face and neck. But you do get used to anything given time.
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#9
RE: 1st post - Sturggling with fatigue - OSCAR results attatched
You have a number of RERAs, Respiratory Effort Related AROUSALS, (We don't like arousal) this means you likely have quite a number of non-event flow limits that would show on a detailed exam of the flow rate. On your machine this is fixed by increasing pressure. In Auto mode set pressure 10-15 since you do have ongoing issues beyond the positional apnea.
In CPAP mode set pressure =11. As long as the RERAs are present we bump pressure up by 1. Do note that some of them are likely to goaway when you beat the positional issue, no amount of pressure from your machine will eliminate that.
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#10
RE: 1st post - Sturggling with fatigue - OSCAR results attatched
Thank you for your help Gideon! I feel that I now have a plan that I can work with -- an hope that things will get better!

I'll let you know how things go,

SeekingSleep
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